6. Treatment of adult-onset and juvenile diabetes
During physical labour the muscles burn glucose and the level of blood glucose drops. The mechanism behind it is that bodily exercise renders the glucose gates more sensitive to insulin, as a result of which more glucose is absorbed by the organs and muscles. And thus prediabetics can keep their blood glucose concentration at a normal level by daily exercise, even without medication; provided that they consume healthy nutrition and avoid an excess of sugar intake.
People with diabetes have been observing a low-carb and sugar-free diet since 1797 (10). It became the standard treatment for diabetes in the 19th century. It limits the rise of the blood glucose level, and with that, the frequent urination and excessive thirst. But when insulin is insufficient or lacking, it is impossible for the organs and muscles to take in enough glucose. So the fatigue and hunger do not disappear. Insulin has been extracted from animal slaughter remnants and injected into diabetics since 1922. This was a life-saving measure for juvenile diabetics. The sugar-free diet no longer made sense and was gradually abandoned. The present dietary recommendations for diabetics dictate regularity in meals using a variety of foods of which approx. half consists of carbohydrates.
For centuries (parts of) plants have been used because of their healing qualities. The flowers of the camomile, for example, were designated to be curative in Norwegian mythology for all kinds of ailments (Balder’s brow). Administering camomile-extract to diabetic rats is found to lower the blood sugar level (3). But this effect has not been demonstrated in humans with diabetes. There have been reports of cinnamon having a blood sugar reducing effect in people (1). The doses used, however, were extremely high and the effect could not be confirmed in later studies. A favourable effect on diabetes is attributed to fenugreek, Gymnema silvestre, Curcuma longa (or turmeric) and Haarlemmerolie (a mixture of sulphur, herbs and terebinth oil). But these data are based on tradition and experience (empiricism). The results have not been compared to an untreated control group, which renders the data of no use scientifically.
The consumption of alcohol causes the blood sugar level to drop, provided that the alcoholic beverage itself does not contain sugar. Alcohol is produced through the fermentation of dextrose. A mere 100 ml of old, thoroughly fermented (dry) red wine still contains 1 to 3 grams of glucose. This may be as high as 28 grams per 100 ml in sweet wines (5). As a result, the blood sugar level initially increases somewhat after consuming wine, only to decrease after that. Beer also contains sugar and, as a result, causes this yoyo-effect. Liquor (gin, whiskey) does not contain sugar. And so such a drink will immediately lower the blood sugar level. This explains how appetizers work: they drop the glucose level what stimulates the hunger centre in the brain. Compared to a control group of total abstainers, significantly less adult-onset diabetes was found after a few years in a group of people who consumed a moderate amount of alcohol on a daily basis (two glasses of wine with dinner) (2).
Medicines for adult-onset diabetes
The sensitivity of the glucose gates in the organ membranes for insulin is increased by physical exercise. Which, in the case of prediabetes, mostly suffices to lower the blood glucose level to normal values. However, in the case of manifest adult-onset diabetes, the use of certain oral drugs is required in addition (table 1). Some of these drugs (upper row) stimulate the glucose gates to open up allowing glucose to enter the organs at a lower insulin level. As a result the blood glucose concentration drops. Other drugs stimulate the β-cells to step up the insulin production (middle row). A third group of drugs inhibits the degradation of the intestinal hormones that stimulate the β-cells to produce insulin (lower row); this increases the incretin-effect, lowering the blood sugar level that way. The treatment of manifest adult-onset diabetes often involves a combination of medicines mentioned in the table (4,6).
Table 1. Blood glucose reducing drugs (4)
|metformine ||500-3000 mg ||Metformine ||increases insulin sensitivity|
|pioglitazon ||15-45 mg ||Actos ||increases insulin sensitivity|
|rosiglitazon ||4-8 mg ||Avandia ||increases insulin sensitivity|
|repaglinide ||0,5-16 mg ||NovoNorm ||stimulates β-cells shortly acting|
|glicazide ||80-240 mg ||Glicazide ||stimulates β-cells long acting|
|glimepiride ||1-6 mg ||Glimepiride ||stimulates β-cells long acting|
|tolbutamide ||500-2000 mg ||Tolbutamide ||stimulates β-cells long acting|
|saxagliptine ||5 mg ||Onglyza ||strengthens incretine-effect|
|sitagliptine ||25-100 mg ||Januvia ||strengthens incretine-effect|
|vildagliptine ||50 mg ||Galvus ||strengthens incretine-effect|
upper row: substances that stimulate the glucose intake in the organs
middle row: substances that entice β-cells to produce insulin
lower row: substances that boost the incretin-effect
More recently developed substances that can lower the blood glucose level in adult-onset diabetes are exenatide and liraglutide. They are called incretin-mimetics because they are synthetic analogs of the intestinal hormones that cause the incretin-effect. And so they too stimulate the β-cells in the pancreas to step up the insulin production. However, these more recently developed preparations have severe side-effects and moreover, they are expensive. And so they are only used on specific medical grounds (7).
Regulation of the blood glucose concentration in juvenile diabetics requires daily injections of insulin. As of 1922, insulin was isolated from the pancreas of animals intended for slaughtering, particularly pigs. It wasn’t until 1982 that synthetic human insulin became available. It contains no animal protein, and so over-sensitivity will not develop even after repeated use. Insulin analogs with varying periods of effectiveness have been available since 1996 (8). Various periods of effectiveness make it possible to achieve a stable blood glucose level for a 24-hour period. To that end a long acting insulin preparation for the basic level is combined with a short-lived preparation in order to set off the glucose peak after meals. Which preparation you are to use depends upon the type of carbohydrates that you eat or drink; the dose depends upon the amount of carbohydrates consumed (8,9).
Table 2. Various types of insulin (9)
|rapid acting ||0-15 min. ||1- 3 hours ||(meal) peak|
|short acting ||30 min. ||1- 4 hours ||(meal) peak|
|medium-long acting ||90 min. ||4-12 hours ||basic level|
|long acting ||30-60 min. ||12-24 hours ||basic level|
Easily digestible sugars in fruit juices or energy drinks require the use of rapidly acting insulin preparations. Carbohydrates that are slower to digest, such as those in bread, require a preparation that releases insulin more slowly. Starch that digests slowly, like potato starch, requires long acting insulin just like the preparation that is used for the basic level.
1. A sugar-free and low-carbohydrate diet will reduce the blood glucose level in diabetics, but the intake of glucose in the organs will remain insufficient or even impossible due to a lack of insulin.
2. A variety of herbs has been used as therapy for diabetes, but these have not been sufficiently researched and their effect is doubtful.
3. Alcohol consumption lowers the blood sugar concentration.
4. Blood glucose reducing medicines for oral use
- stimulate the absorption of glucose in the organs or
- incite the β-cells to step up the production of insulin or
- boost the incretin-effect.
5. There is a range of synthetic insulins available for the regulation of the blood glucose level with different speeds of insulin release.
1. Diabetes Fonds (2011). Verlaagt kaneel de bloedsuiker?
2. Joosten M (2011). Thesis Wageningen University. Moderate alcohol consumption, adiponectin, inflammation and type 2 diabetes risk.
3. Kato A, Minoshima Y, Yamamoto J, Adachi I, Watson AA and Nash RJ (2008). J Agric Food Chem; 56(17): 8206-11; Protective effects of dietary chamomile tea on diabetic complications.
4. Kooy A (2010). Diabetes Mellitus; nieuwe inzichten en behandelingsopties anno 2010; ISBN 978-90-313-7434-2
5. Robin990 (2015). Diabetes en rode wijn: een gezonde combinatie
6. Sitsen JMA, Vasbinder E. Geneeskundig jaarboek 2011; 128e jaargang; ISBN 978-90-313-8614-7
7. Tack CJ en Stehouwer CDA. Diabetes mellitus. In: Interne geneeskunde. eds. Stehouwer, Koopmans en van der Meer. 14e druk (2010); ISBN 978-90-313-7360-4; p 842-843
8. Wikipedia.nl (2016). Insuline
9. Wikipedia.nl (2016). Insulinetherapie
10. Wikipedia.en (2016). Low-carbohydrate diet
© Leo Rogier Verberne
Juvenile, Adult-onset and Monogenic diabetes
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